<!DOCTYPE html>
<html>
<head>
<meta charset="UTF-8">
<title>${survey.name}-问卷预览</title>
 <meta name="viewport" content="width=device-width, initial-scale=1">
 <link rel="icon" type="image/png" href="${Domain}common/amazeui/i/favicon.ico">
<link rel="stylesheet" href="${Domain}common/amazeui/css/amazeui.min.css" />
<script src="${Domain}common/amazeui/js/jquery.min.js"></script>
<script src="${Domain}common/amazeui/js/amazeui.min.js"></script>
<style type="text/css">
.tngou-input-bottom{
border: 0;
border-bottom: 1px solid rgba(0, 0, 0, 1);
}
.tngou-input
{
border: 0;
}

.am-table .tngou-thead  th {
    border:0px;
    padding:0px;
    width: 8.333333333%;
}

</style>
</head>
<body style="background-color: #999;">
<div class="am-container" style="width:794px;background-color: #FFFFFF;min-height: 1090px">
<div class="am-g" >
<div class=" am-print-hide am-margin-top-sm am-fr " >
<a type="button" class="am-btn am-btn-sm am-btn-default" href="${Domain}common/doc/info.doc"><i class="am-icon-download"></i>下载</a>
<button type="button" class="am-btn am-btn-sm am-btn-default " onclick="window.print();"><i class="am-icon-print"></i> 打印</button>
<button type="button" class="am-btn am-btn-sm am-btn-default " onclick="javascript:window.opener=null;window.open('','_self');window.close();"><i class="am-icon-close"></i> 关闭</button>
</div>
</div>
<h3 align="center" class="am-margin-top-lg">
${survey.name}
</h3>
 <#if survey.type=1>
<div class="am-u-sm-12">
<div class="am-fl">
<strong>姓名：</strong><input type="text"  class="tngou-input-bottom">
</div>
<div class="am-fr">
<strong>编号：</strong><input type="text"  class="tngou-input-bottom">
</div>
</div>
</#if>
<div class="am-g" >
<form class="am-u-sm-12 am-margin-top-lg" >

<table class="am-table  am-table-bordered " >

   		
  
    <tbody>
   		<tr class="tngou-thead"><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th> </tr>
        <tr class="tngou-thead"><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th> </tr>
      
        <tr>
            <td colspan="2" align="center">姓名</td>
            <td colspan="4"><input type="text" class="tngou-input"></td>
            <td colspan="2" align="center">性别</td>
            <td colspan="4">          
	           <label class="am-checkbox-inline">
			    <input type="radio" name="sex"  value="1"  data-am-ucheck> 男
			  </label>
			  <label class="am-checkbox-inline">
			    <input type="radio" name="sex"  value="2"  data-am-ucheck > 女
			  </label>
 
		  </td>
        </tr>
        <tr>
            <td colspan="2" align="center">出生日期</td>
            <td colspan="4"><input type="text" class="tngou-input"></td>
            <td colspan="2" align="center">年龄</td>
            <td colspan="4"><input type="text" class="tngou-input"></td>
        </tr>
        <tr>
            <td colspan="2" align="center">身份证号</td>
            <td colspan="4"><input type="text" class="tngou-input"></td>
            <td colspan="2" align="center">名族</td>
            <td colspan="4"><input type="text" class="tngou-input"></td>
        </tr>        
        <tr>
            <td colspan="2" align="center">本人电话</td>
            <td colspan="4"><input type="text" class="tngou-input"></td>
            <td colspan="2" align="center">其他联系</td>
            <td colspan="4"><input type="text" class="tngou-input"></td>
        </tr>
        <tr>
            <td colspan="2" align="center">户籍地址</td>
            <td colspan="10"><input type="text" class="tngou-input"></td> 
        </tr>
        
        <#if survey.type=2>
        <tr>
            <td colspan="2" align="center">现居地址</td>
            <td colspan="10"><input type="text" class="tngou-input"></td> 
        </tr>
        <tr>
            <td colspan="2" align="center">诊断疾病</td>
            <td colspan="4"><input type="text" class="tngou-input"></td>
            <td colspan="2" align="center">部位</td>
            <td colspan="4"><input type="text" class="tngou-input"></td>
        </tr>
         <tr>
            <td colspan="2" align="center">确诊时间</td>
            <td colspan="4"><input type="text" class="tngou-input"></td>
            <td colspan="2" align="center">就诊编号</td>
            <td colspan="4"><input type="text" class="tngou-input"></td>
        </tr>
        <tr>
            <td colspan="2" align="center">治疗科室</td>
            <td colspan="10"><input type="text" class="tngou-input"></td> 
        </tr>
         <tr>
            <td colspan="2" align="center">主管医生</td>
            <td colspan="10"><input type="text" class="tngou-input"></td> 
        </tr>
        
        </#if>
        <#list trs as tr>
        <tr>
        <#list tr as td>
        
        <td  colspan="${td.colspan}"  rowspan="${td.rowspan}" <#if td.align==1>align="center"</#if> >
      	<#switch td.type>
		<#case 0>${td.tag}<#break>
		<#case 1> ${td.name}<#break>
		<#case 2>
		     <#switch td.qusetiontype>
		     <#case 0>
			     <label class="am-checkbox-inline">
				    <input type="radio" name="${td.id}"  value="1"  data-am-ucheck> 是
				  </label>
				  <label class="am-checkbox-inline">
				    <input type="radio"  name="${td.id}"  value="0"  data-am-ucheck > 否
				  </label>
			  <#break>
			   <#case 1>
				   <#list td.list as item>
			      <label class="am-checkbox-inline">
				    <input type="radio"  name="${td.id}"  value="${item.value}"  data-am-ucheck> ${item.name}
				  </label>
				 </#list>
			  <#break>
			  <#case 2>
				   <#list td.list as item>
			      <label class="am-checkbox-inline">
				    <input type="checkbox"  name="${td.id}"    value="${item.value}"  data-am-ucheck> ${item.name}
				  </label>
				 </#list>
			  <#break>
		     <#case 3>
				   <#list td.list as item>
			      <input type="text" style="width:33.3%"  name="${td.id}"  class="tngou-input">${item.name}
				 </#list>
			  <#break>
			  <#case 4>
			      <input type="text" style="width:80%" name="${td.id}"   class="tngou-input">
			  <#break>
		     <#default>
		        <input type="text" style="width:80%"   class="tngou-input">
		     </#switch>
		<#break>
		<#default>
		</#switch>
       
        
        </td>
        </#list>
        </tr>
        </#list>
         <tr>
             <td colspan="2" align="center">受访关系</td>
            <td colspan="10">
           	<label class="am-checkbox-inline">
			    <input type="checkbox"  value="0"  data-am-ucheck> 自己
			  </label>
			  <label class="am-checkbox-inline">
			    <input type="checkbox"   value="1" data-am-ucheck> 夫妻
			  </label>			  
			  <label class="am-checkbox-inline">
			    <input type="checkbox"   value="2" data-am-ucheck> 子女
			  </label>
			  <label class="am-checkbox-inline">
			    <input type="checkbox"   value="3" data-am-ucheck> 父母
			  </label>
			  <label class="am-checkbox-inline">
			    <input type="checkbox"   value="4" data-am-ucheck> 亲人
			  </label>	
			  <label class="am-checkbox-inline">
			    <input type="checkbox"   value="5" data-am-ucheck> 朋友
			  </label>		
            </td> 
        </tr>
         <tr>
            <td colspan="2" align="center">建档日期</td>
            <td colspan="2"><input type="text" style="width:80%" class="tngou-input"></td>
            <td colspan="2" align="center">建档机构</td>
            <td colspan="2"><input type="text" style="width:80%" class="tngou-input"></td>
		  <td colspan="2" align="center">建档人</td>
            <td colspan="2"><input type="text" style="width:80%" class="tngou-input"></td>
        </tr>
    </tbody>
</table>
</form>
</div>


</div>



</body>
</html>